Risk factors of intraoperative and 24-hour postoperative cardiac arrest in geriatric patients in non-cardiac surgery

Abstract

Background & aim. The study aimed to identify preventable risk factors for the occurrence of intraoperative and 24-hour postoperative cardiac arrest in geriatric patients. Methods. This was a matched case-control study. Patients aged 65 and older who experienced intraoperative and 24-hour postoperative cardiac arrest between 2011 and 2018 were consecutively recruited into the case group. Cases were matched with controls by sex, age range, and in the same year of surgery in the ratio of 1:3. The outcome was the occurrence of intraoperative and 24-hour postoperative cardiac arrest. Univariate and multivariate logistic regression analyses were carried out to identify factor related outcomes. Results. From a total of 20,024 geriatric patients, 98 cases and 294 controls were recruited. The risk factors of intraoperative and 24-hour postoperative cardiac arrest were ASA classifications 3 (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.24-12.62) and 4 (OR 8.46, 95% CI 2.15-33.36) compared to ASA classification 2, aortic surgery (OR 16.86, 95% CI 2.9-97.99) compared to trunk and perineal surgery, potassium imbalance (OR 2.71, 95% CI 1.02-7.22), and receiving preoperative benzodiazepine (OR 3.92, 95% CI 1.36-11.28). Regional anesthesia (OR 0.18, 95% CI 0.04-0.83) and propofol (OR 0.09, 95% CI 0.03-0.24) were found to be protective factors. Conclusions. The study found that potassium imbalance might be a preventable risk factor. If feasible, performing regional anesthesia while avoiding preoperative benzodiazepine is recommended.